Labor & Birth Proceses Flashcards
(76 cards)
1
Q
6 Ps
A
- Powers: contractions
- Passenger: fetus & placenta
- Passageway: birth canal
- Position of mother
- Psyche/People
2
Q
Primary Powers
A
- Involuntary uterine contractions
- Signal beginning of labor
- Forces generated by uterine musculature (fundus)
3
Q
How are Uterine Contractions Measured
A
- Frequency: the time from the beginning of one contraction to beginning of next
- Amplitude/Intensity: strength of contraction at its peak
- Duration: length of contraction
4
Q
Primary Powers - Responsibility
A
- Effacement: shortening & thinning of cervix during 1st stage of labor
-
Dilation of Cervix: enlargement or widening of cervical opening & cervical canal
> occurs once labor has begun, 1cm-10cm - Descent of Fetus
5
Q
Powers Assessment - Manual Palpation
A
- Palpate the fundus throughout a contraction to determine intesnity
- As well as observation
6
Q
Powers Assessment - Tocodynamometry
A
Used to measure frequency, intensity, and duration of uterine contractions
7
Q
Powers Assessment - Intrauterine Pressure Catheter (IUPC)
A
A device placed into the amniotic space during labor in order to measure the strength of uterine contraction
8
Q
Secondary Powers
A
- Once the cervix is dilated, then the mother can begin VOLUNTARY bearing down efforts to actively aid in the expulsion of fetus
- No effect on cervical dilation
- Incrd intraabdominal pressure tht compresses the uterus on all sides and adds power of expulsive forces of fetus
9
Q
What Causes Maternal Urge to Bear Down/Ferguson Reflex
A
Stretch receptors in posterior vagina cause release of endogenous oxytocin
10
Q
Passenger
5
A
-
The way the passenger (fetus) moves through the birth canal is determined by:
> the size of the fetal head (major factor)
> fetal presentation
> fetal lie
> fetal attitude
> fetal position - Placenta is considered a passenger too bc it passes through the birth canal
11
Q
After the Rupture of Membranes through Palpation of the Fontanels & Sutures they can Determine
A
- Fetal presentation
- Position
- Attitude
12
Q
Fontanels
A
The area where two or more bones meet
13
Q
During Labor Fontanels/Sutures Accomodate How
A
- Sutures & fontanels are flexible to accomodate the infant’s birth
- Slight overlapping or modeling occurs during labor to allow for accomodation of the fetal head through bony pelvis
14
Q
Fetal Position
A
- A relationship of a reference point on the presenting part to the 4 quadrants of the mother’s pelvis
- R: right of mother’s pelvis
- L: left of mother’s pelvis
- O: occiput
- S: scarum
- M: mentum (chin)
- Sc: scapula
- A: anterior
- P: posterior
- T: transverse
15
Q
Station
A
- The relationship of the presenting fetal part to an imaginary line drawn btwn the maternal ischial spines & is measure of the degree of descent of the presenting part of fetus through birth canal
- Bottom of Symphysis pubis is 0
16
Q
When is Birth Imminent
A
When the presenting part is at 4-5+ cm
17
Q
When Should the Station of the Presenting Part be Determined
A
When labor begins so the rate of descent of the fetus during labor can be assessed accurately
18
Q
Fetal Lie
A
- Longitudinal axis (spine) of fetus relative to longitudinal axis (spine) of uterus/mother
-
Preferred Direction: longitudinal (vertical)
> head down -
Transverse/horizontal/oblique lie cannot have a vaginal birth
> fetus spine at 90 degrees to mom’s spine
19
Q
Fetal Presentation
A
- Fetal part tht enters the pelvic inlet 1st and leads through the birth canal during labor at term
-
Vertex presentation
> fetal head down
20
Q
3 Fetal Presentations
A
- Cephalic: head, preferable
- Breech: butt/feet first
- Shoulder: rare
21
Q
Fetal Presentations - Compound
A
-
Presence of 1 fetal part over pelvic inlet
> like a hand on the face
22
Q
Fetal Presentation - Attitude
A
- The relation of the fetal body part (head) to one another (spine)
- General Flexion: the arms are crossed over the thorax, umbilical cord lies btwn arms & legs
- Flexion allows smallest diameter of fetal head to present at pelvic inlet
23
Q
Fetal Presentation - The Presenting Part
A
- The part of the fetus tht lies closest to the internal os of the cervix
- Part of the fetal body 1st felt by examining finger during a vaginal exam
-
Factors tht Determine Presenting Part:
> fetal lie
> fetal attitude
> extension/flexion of fetal head
24
Q
Fetal Size
A
- Abdominal palpation or ultrasound
- Macrosomia (>4500g) associated w/ failure to progress
25
Passageway - Pelvis
- **True Pelvis**: part involved in birth
- **False Pelvis**: part above the brim and plays no part in childbearing
- **Classic female pelvis = Gynecoid**
26
Passageway - Soft Tissues
- **Cervix**: contractions of the uterine body push fetus into cervix
> the cervix effacement (thins) and dilates (opens) to allow the fetus to pass into vagina
27
Passageway - Pelvic Floor
**Helps the fetus rotate anteriorly as it passes through birth canal**
28
Position
- **Maternal positions can promote comfort and enhance labor progress**
- Frequent movement relieves fatigue, incrs comfort, and promotes circulation
- The best thing for labor is movement
> if no epidural
29
Passageway - Preferred Angle
- **Subpubic Angle**: a rounded wide arch is preferred for birth
- Determined at the 1st prenatal appointment
30
Psyche & People
- **Psyche**
> how she copes
> perceives pregnancy/labor
- **People**
> support system
- **Education**
> prenatal care
> preconception counseling
> breastfeeding classes
> baby basic classes
> childbirth classes
31
Signs of Preceding LABOR
**LABOR**
- **Lightening/Lower back pain**
> uterus sinking downward & forward; more bladder pressure
> abt 2 weeks before labor
- **A drop in weight (0.5-1.5kg)**
> water loss
- **Bloody show**
> incrd vaginal discharge
- **Owl's like nesting behaviors**
> burst of energy
- **Ripening of cervix**
> soft/dilate
32
Stages of Labor Consist of
- **Regular progression of uterine contractions**
- **Progressive effacement & dilation of cervix**
- **Progressive descent of presenting part**
33
First Stage of Labor
- **Onset of uterine contractions until full effacement/dilation of cervix**
- **Early (Latent)**: more progress in effacement of cervix & little incr in descent
> 3cm of dilation
- **Active**: more rapid dilation of cervix & an incrd rate of descent of presenting part
> 4-7cm of dilation
- **Transition**:
> restless/irritable
> urge to push
> rectal pressure
> most difficult part of labor
> 8-10cm of dilation
- **Nursing Intervention**: determine if its true or false labor
34
What is the Longest Phase of Labor
**1st - Early (latent)**
35
1st Stage - True vs False Labor
- **True**
> begins in lower back & extends from back to abdomen
> incrses in intesity, frrequency, duration
> change in cervix: softening, effacement, dilation, more anterior position
- **False**
> confined to lower abdomen
> does not incr in intensity, frequency, duration
> no change in cervix
> walking/position may relieve discomfort
> presenting part may not be engaged
36
Labor Definition
**Regular uterine contractions tht cause cervical change (dilation)**
37
1st Stage of Labor - Assessment
- **1st Priority**: FHR - tocotransducer/ultrasound
> maternal vital signs
- **Gathering Data**
> last meal; important for surgery
> OB/prenatal hx
> group b strep (GBS) status: start antibiotics if positive
38
Vaginal Exam
- **Effacement**: measure in percentages
- **Dilation**: measure in cm
39
1st Stage of Labor - Phsyical Assessment
- **Phsyical Exam**
> mom's VS & FHR + pattern
> uterine contractions
> vaginal exam: same person checks her time to prevent false reading its subjective
- **Leopold Maneuvers**
> performed through abdominal palpation, determines fetal location
40
1st Stage of Labor - Labs/Diagnostic Test
- **Urine test**
- **Blood test**
- **Assessment of amniotic membranes/fluid**
41
1st Stage of Labor - Nursing Intervention
- **Oral intake**
- **IV intake**
- **Voiding**
- **Catheterization**
- **Bowel elimantion**
- **Ambulation**
- **Positioning**
- **Support to pt & fam**
- **General hygiene**
42
2nd Stage of Labor
- **Cervix fully dilated (10cm) & 100% effacement to complete birth of fetus**
- **Latent**: passive fetal descent through birth canal, body does the work
> contractions help force baby further down birth canal
- **Active (Descent)**: pushing phase
> urge to push/bear down (voluntary power)
43
Optimal Conditions for Descent
- **Spontaneous urge**
- **Position**: occiput anterior (OA)
- **Quality of contraction**
- **Station >+1**
> ideally +3
44
2nd Stage of Labor - Care Management
- **Preparing for Birth**
> Mom: maternal position, bearing down efforts, support of father
> Fetus: FHR & pattern
- **Optimal Position for Mother**
> squatting, makes pelvis wider
> lithotomy is typical position
45
Mechanism of Birth - What Presentation do we Want
**Vertex presentation**
46
Bearing Down - Directed/Closed Glottis
- **Mom**
> PUSH
> exhaustion
> holding breath
> counting
> physiological & emotional effects
- **Fetus**
> dcr oxygen to fetus
47
Bearing Down - Spontaneous/Open Glottis
- **Mom**
> women push several times during contractions
> fewer pelvic floor complication
> efforts vary in intensity/duration
> less fatigue
- **Fetus**
> fewer operative births
> less fetal acidosis
48
2nd Stage of Labor - Assessment
- **Assessment**
> bulging perineum
> labial separation
> visible caput (head), obvious descent
- **Perineal trauma r/t childbirth**
> perineal lacerations
> vaginal & urethral lacerations
> cervical injuries
> episiotomy
49
3rd Stage of Labor
- **Birth of infant to delivery of placenta**
- Shortest stage: 5-10 minutes
50
How do we Know 3rd Stage is Almost Complete
- **Firmly contracting fundus**
- **Sudden gush of dark blood from introitus**
- **Vaginal fullness**
- **Apparent lengthening of umbilical cord**
- **Shape of uterus changes**
51
3rd Stage of Labor - Interventions
- **Mom's VS q15mins**
- **Assess for placental separation & amnt of blood**
- **Assist mom w/ bearing down to facilitate expulsion of placenta**
52
4th Stage of Labor
**Delivery of placenta to when mother becomes stable**
typically 1 hour
53
4th Stage of Labor - Assessment
- **Fundus/bleeding**
- **Perineum**
> laceration/episiotomy
- **VS/pain**
54
4th Stage of Labor - Newborn Assessment
- **Thermoregulation**
> skin to skin w/ mom is best
- **Breastfeeding**
> begin bf at this time
55
4th Stage of Labor - Intervention
- **Active management**
- **Greatest risk is hemorrhage**
> priority!
56
Labor Refers to
**The process of moving the fetus, placenta, and membranes out of the uterus & through birth canal**
57
Multiparous Woman Lightening Occurs When
**May not take place until uterine contractions are established & true labor is in progress**
58
Mechanism of Labor
- **Refers to the fetal adaptations it must make during its descent through birth canal**
- **(A) Engagement**
- **(A) Descent**
- **(B) Flexion**
- **(C) Internal Rotation**
- **(D) Extension**
- **(E) Restitution/External Rotation**
- **(F) Expulsion**
59
Engagement
**When the biparietal diameter of head passes pelvic inlet, head is said to be engaged in pelvic inlet**
60
Descent
- **Refers to progressing part through pelvis**
> pressure by amniotic fluid
> pressure exerted by sontracting fundus on fetus
> force of contraction of maternal diaphragm/abdominal mm in 2nd stage of labor
> extension & straightening of fetal body
61
Flexion
**Once pressure is felt from cervix, pelvic wall, or pelvic floor the fetus flexes so the chin is brought closer to chest**
62
Internal Rotation
- **The maternal pelvic inlet is widest in transverse diameter**
- **Fetal head passes inlet into true pelvis in occipitotransverse position**
- **Head must rotate**
> begins at ischial spine
63
Extension
- **Occiuput passes under lower border of symphysis pubis 1st then head emerges bu extension**
- Occiput > Face > Chin
64
Restitution
- **After head is born, it rotates briefly to position it occupied when it was engaged in inlet**
- **External Rotation**: occurs as the shoulders engage
65
Expulsion
- **After birth of shoulders**
- Head & shoulders are lifted up toward the mother's pubis bone
- Trunk of baby is born by flexing laterally in direction of symphysis pubis
66
Physiological Adaptations - Fetal
- **Fetal HR Fluctuates in Response to**
> fetal movement
> vaginal exam
> fundal pressure
> uterine contractions
> fetal head compression
> **normal FHR: 110-160bpm**
- **Fetal Circulation is Affected by**
> maternal position
> uterine contractions
> BP
> umbilical cord blood flow
> **most healthy fetuses can compensate for these changes**
67
Physiological Adaptations - Fetal Respiration
- **Fetal lung fluid**
> cleared through air passages as infant passes birth canal & vagina
> the process of labor helps absorb some of the fluid before birth
- **ABGs**
> PO2 dcrs, PCO2 incrs, arterial pH dcrs, HCO3 dcrs
- **Fetal Respirations**
> movements dcr during labor
68
Physiological Adaptations - Maternal: Cardiovascular Changes
- **Heart**
> Incrd SV; 300-500mL is shunted from uterus to vascular syst w/ contractions
> carbon dioxide during contractions incrs by 50% above baseline
> carbon dioxide peaks 10-30 mins post birth & returns to pre-labor baseline in 1st hr of postpartum
- **Vascular**
> BP incrs during contractions & returns to baseline btwn contractions
- **Blood Cells**
> WBC incr; stress of labor
69
Physiological Adaptations - Maternal: Respiratory Changes
- **Incrd O2 consumption**
- **Hyperventialtion turns into resp alkalosis, hypoxia, hypocapnia**
70
Physiological Adaptations - Maternal: Endocrine Changes
- **What hormones trigger labor**
> dcrd progesterone
- **What hormones incr during labor**
> incrd estrogen
> incrd prostaglandins
> incrd oxytocin
- **Blood Sugar Response**
> glucose lvls dcr w/ the work of labor
71
Supine Hypotension
**Occurs when ascending vena cava & descending aorta are compressed**
72
Physiological Adaptations - Maternal: Renal Changes
- **Difficulty voiding**
- **Proteinuria +1 is normal**
> Muscle breakdown
73
Physiological Adaptations - Maternal: Integumentary Changes
**Vaginal introitus (entrance to vagina) results in stretching/distention**
74
Physiological Adaptations - Maternal: Musculoskeltal Changes
- **Incrd stress**
- **Progesterone/Relaxin**
- **Backache, joint aches, leg cramps**
75
Physiological Adaptations - Maternal: Neuro Changes
- **Sensorial changes**
> euphoria
- **Endorphins**
- **Physiologic anesthesia of perineum**
76
Physiological Adaptations - Maternal: GI Changes
- **Dcrd absorption & motility of gut**
> N/V/D
